DOXEPIN 6 mg Tablet, Film Coated
Coverage in Wisconsin (CMS PDP Region 16).
5 of 10 stand-alone Part D plans in Wisconsin cover this drug on tier 2–4.
Lowest 30-day cost $10.00 at a preferred pharmacy. 5 of 5 plans apply a prior authorization, step therapy or quantity limit.
27 Medicare Advantage plans in WI do cover it
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D. A patient on an MA-PD plan may have coverage even where no PDP lists the drug. WI: 27 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $1.3311 | $3.993 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $5.1849 | $15.553 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 26% | 26% | $5.6460 | $16.943 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $3.4284 | $10.293 units |
|
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $6.3146 | $18.943 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity.